Family Living Focus: Caring for Adults with Cognitive and Memory Impairments
Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor
Emeritus, University of Minnesota
Caregiving: A Universal Occupation:
Most people will become caregivers or need one at some point in their lives.
A caregiver is anyone who provides basic assistance and care for someone who
is frail, disabled, or ill and needs help. Caregivers perform a wide
variety of tasks to assist someone else in his or her daily life, for
example, balancing a checkbook, grocery shopping, assisting with doctor’s
appointments, giving medications, or helping someone to eat, take a bath or
dress. Many family members and friends do not consider such assistance and
care as “caregiving.” They are just doing what comes naturally to them –
taking care of someone they love. That care may be required for months or
years, and may take an emotional, physical, and financial toll on caregiving
families.
For some people, caregiving occurs gradually over time. For others, it can
happen overnight. Caregivers may be full- or part-time; live with their
loved one or provide care from a distance. For the most part, friends,
neighbors, and most of all, families, provide the vast majority of care
usually without pay.
Many American families care for an adult with a cognitive (brain)
impairment. Cognitively impaired people have difficulty with one or more of
the basic functions of their brain, such as perception, memory,
concentration, and reasoning skills. Common causes of cognitive impairment
include Alzheimer’s disease and related dementias, stroke, Parkinson’s
disease, brain injury, brain tumor, or HIV-associated dementia. Although
each disorder has its own unique features, family members and caregivers
often share common problems, situations, and strategies.
Caregiving and Cognitive Impairment:
Cognitive and memory impairments can change how a person thinks, acts,
and/or feels. These changes often present special challenges for families
and caregivers. An ordinary conversation, for example, can be quite
frustrating when your loved one has difficulty remembering from one moment
to the next what has been said.
Individuals with moderate to severe dementia or another cognitive impairment
often require special care, including supervision (sometimes 24 hours a
day), specialized communication techniques and management of difficult
behavior. They may need help with activities of daily living (called
“ADLs”), such as bathing, eating, transferring from bed to a chair or
wheelchair, toileting, and/or other personal care.
Challenging Behaviors:
Individuals with cognitive impairment may experience a range of behavioral
problems that can be frustrating for caregivers. These might include
communication difficulties, perseveration (fixation on/repetition of an idea
or activity), aggressive or impulsive behaviors, paranoia, lack of
motivation, memory problems, incontinence, poor judgment and wandering.
Some people may develop behavioral problems early on, while others go
through their entire illness with only minor issues. Most cognitively
impaired people fall somewhere in the middle, having good days and bad days
(or even good or bad moments). Anticipating that there will be ups and
downs, and maintaining patience, compassion, and a sense of humor will help
you cope more effectively with difficult behavior. It is important to
remember that it is the disease, not the person, causing the behavior.
Helpful suggestions for managing these problems include communication
techniques, such as keeping language simple and asking one question at a
time. Break down tasks and questions. For example, instead of asking,
“Would you like to come in and sit down and have a snack?” use simple
statements such as, “Sit down here.” and “Here’s a snack for you.”
